Individual provider Active NPI

Harendra Keshavlal Punatar, M.D.

  • Cardiovascular Disease Physician
  • Santa Rosa, CA
National Provider Identifier
1699773432
Registry record updated Feb 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A40868 Issued in CA
Practice address
3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634
Phone
(707) 573-6166
Fax
(707) 573-6165
NPI assigned
Jul 13, 2005
Last updated
Feb 8, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X A40868 CA Primary
Interventional Cardiology Physician 207RI0011X A40868 CA

Addresses

Primary practice location

3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634

Mailing address

3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634
Phone (707) 525-6485

Other identifiers 3

IdentifierTypeStateIssuer
00A408680OtherCABLUE SHIELD OF CALIFORNIA
00A408680MedicaidCA
060017510OtherCARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A40868CAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Health Northern California, LLC CurrentSince Mar 1, 2021 Accepting new patients
St. Joseph Health Northern California, LLC Current Accepting new patients
St. Joseph Health Northern California, LLC CurrentSince Mar 1, 2021 Accepting new patients

Locations

3300 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3361

1000 Trancas St
Napa, CA 94558
Phone (707) 226-2901

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328659200000",
    "number": "1699773432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE",
            "address_2": "STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-525-6485",
            "fax_number": "707-573-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE",
            "address_2": "STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-573-6166",
            "fax_number": "707-573-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUNATAR",
        "first_name": "HARENDRA",
        "middle_name": "KESHAVLAL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2012-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A40868",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A40868",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "00A408680",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A408680",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060017510",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.